Driver Safety for Seniors: Assessment & Resources

After she pondered the fact that she learned how to drive as a teenager, 72-year-old Marjorie Butler Norrie signed up for the AARP Driver Safety Program refresher course.

“We think that we’re driving like we used to drive, but [I learned] our reactions have slowed down so much, not realizing that we don’t react as well as we used to,” says Butler Norrie, who resides in Wenatchee, Wash.

In the class, Butler Norrie learned about senior driver safety and age-related changes that can affect her driving abilities. Perhaps these shifts are why she had already begun to limit her driving. She rarely travels on big city freeways, and she didn’t drive for a month last winter, saying snowy conditions kept her off the road.

This self-restriction and self-assessment are common and healthy practices for older drivers. Examining your own driving proficiency can keep you safe. After age 75, the risk of being in a collision increases for every mile a person drives, according to the Insurance Institute for Highway Safety. Statistically, this age group falls just below teenagers for the number of fatal crashes. Although this ominous fact is linked to an older person’s ability to endure injury, older drivers-and their loved ones-need to pay attention to driving skills and make the appropriate adjustments, whether that means adapting their driving habits or hanging up their car keys for good.

A Self-Assessment Tool

The AAA Roadwise Review, available on CD-ROM from AAA.com, measures functional abilities shown to be the strongest predictors of crash risk among older drivers:

• Leg strength and general mobility
• Head/neck flexibility
• High- and low-contrast visual acuity
• Working memory
• Visualization of missing information
• Visual search
• Useful field of view

Age-Related Changes

As people age, the following can affect their driving abilities and impact senior driver safety:

• Vision and Hearing Loss: Vision declines with age due to physiologic changes and to diseases such as glaucoma. Regular hearing check-ups are imperative, since safe driving means hearing emergency sirens, honking, and sounds such as bells at railroad crossing.
• Cognition: When you drive, you need to integrate several skills at the same time, including memory, visual processing, and attention. Both our speed of processing and judgment can become impaired, jeopardizing driving skills.
• Motor Function: As people age, their joints become stiffer, muscles weaken and flexibility lessens. Turning your head to view traffic, using the steering wheel, and operating the gas and brake pedals can become more difficult.
• Medications: Certain medications can reduce driving skills, including antihistamines, sleep aids, and medications for depression, diabetes, and pain reduction. Always ask your doctor how new medications will affect your driving.
• Medical Conditions: ALS, Alzheimer’s disease, dementia and memory disorders, diabetes, head trauma, high- or low-blood pressure, multiple sclerosis, nervous system disorders, Parkinson’s disease, severe arthritis, severe elderly depression, sleep disorders, stroke effects, surgery after effects, thyroid disease, and the use of medical devices including automatic defibrillators and pacemakers.

But age also reaps experience. “Older drivers have wisdom that may make them much better drivers. Teenagers don’t have years of driving behind them,” says Lissa Kapust, the Clinical Coordinator of DriveWise, a driving fitness evaluation program at Boston’s Beth Israel Deaconess Medical Center. “Older drivers who do self-monitoring-if they are tired or the weather is bad-this can be a critical factor in maintaining safety.”

Driving Classes

Taking a class is a good way to assess your own skills and stay safe on the road. Elderly resources like the AARP Driver Safety Program refresher course is the first and largest course created for adults 50 and older. The 8-hour low-cost course is usually taught in two four-hour sessions, or people can complete an online course in a 30-day timeframe (call toll-free at (888) 227-7669). Upon completion, most auto insurance companies provide a discount. “We assess our health from time to time; we should assess our driving from time to time and make adjustments based on our assessment of our own driving,” says Brian Greenberg, Coordinator for the AARP Driver Safety Program. “Just think of it as a driver tune-up.”

The class looks at 15 warning signals that might mean a person should limit or stop driving. According to Greenberg, the following five warning signs signal the need for a formal driving assessment:

1. Frequent dents or scrapes on the car or on fences, garage doors, curbs, etc.
2. More traffic tickets or warnings in the last year or two
3. Having crashes, minor accidents, or almost crashing
4. Trouble paying attention to or missing signals, road signs, and pavement markings
5. Difficulty staying in the lane of travel or changing lanes

Professional Assessments: Resources for Elderly Drivers

Perhaps you have noticed a loved one’s deteriorating driving abilities, but she denies any problem during conversations. An independent, objective evaluation can both judge driving competence and give a voice of authority to a decision. Completed at rehabilitation centers, hospitals, and Veterans Administration Medical Centers, these tests are usually administered by occupational therapists or driver rehabilitation specialists. Because medical providers realize they can test a patient’s hearing and vision but cannot judge his driving skills, your loved one’s doctor may be able and willing to give you a referral for a senior driver safety assessment. “It’s such an important decision, physicians don’t want to err on the side of prematurely taking away a license, and they don’t want to wait until it’s too late,” says Kapust. “One’s license is the most important marker for self esteem in the elderly. The loss of the license really marks the entrance into old age.”

Because people fear the end of driving, a person very rarely comes in voluntarily to a place like DriveWise. Doctors, adult children, community agencies, or a driving registry often refer people, says Kapust. A social worker begins the evaluation, discussing reasons for the referral and how the loss of driving would affect the patient. A short neuropsychological exam is given; an occupational therapist assesses the person’s vision, flexibility, strength, and cognition; and a road test is taken. Two weeks later, the patient meets with the social worker to review the DriveWise recommendations.

After an assessment, a driver often works with an occupational therapist that provides rehabilitation to strengthen skills used in driving. Often the therapist helps fit the car around the person. Devices include parabolic mirrors that yield a panoramic view; knobs or a spinner wheel on the steering wheel; and hand controls for the accelerator and brakes. Often people learn safe driving rules, such as:

• Don’t drive with the radio on or converse with your passengers or use cell phones
• Keep your car in the best shape, with tune-ups, good windshield wipers, aligned headlights, etc
• Always wear seatbelts
• Drive with your headlights on
• Make sure there is enough space between both the cars in front of you and the car behind you

When to Hang Up The Keys

Sometimes an assessment means the driver is told she needs to stop driving. Or perhaps a person has come to the decision on his own, realizing driving is too stressful, and it’s time to retire the car keys. “Often we hear from patients and families it’s a loss that they never get over. They may have a memory loss but they don’t forget that somebody has taken away their keys,” says Kapust.

She points out that few people will drive until they die and actively involving the person in the decision to stop driving helps. People link the cessation of driving to an end of independence, so it’s important to keep people engaged in activities they enjoy, and to emphasize that retiring from driving is a normal part of aging.

Richard Hackel, a former DriveWise patient, made the decision to stop driving on his own. He suffers from ALS or Lou Gehrig’s disease, and the muscles that would normally hold his left leg straight are not functional. At age 64, he worried about controlling the car in an emergency situation. “I want to live as long as I can and minimize the possibility that I could cause injury to anyone else,” says Hackel, who lives in Brookline, Mass. “That loss of independence is an adjustment that everybody has to make, but I’d rather be alive and able to enjoy life than driving and risk hurting myself or someone else.”